Comparison of antemortem clinical diagnosis and post-mortem findings in intensive care unit patients

Rusu, Ștefan; Lavis, Philomène; Salgado, Vilma Domingues; Craynest, Marie-Paule Van; Créteur, Jacques; Salmon, Isabelle; Brasseur, Alexandre; Remmelink, Myriam

doi:10.1007/s00428-020-03016-y

Cited by 12 publications

(3 citation statements)

References 45 publications

(104 reference statements)

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“…One recent domestic study reported a 26.1% discrepancy rate between ante and postmortem diagnoses, and another retrospective study in Brussels reported a 23.1% discrepancy. 4 , 5 These studies support the findings of the retrospective study of the ongoing relevance of autopsies performed at Jackson Memorial Hospital in 2016, which found that 19.5% of the autopsies included in the study displayed major discrepancies in the pre and postmortem diagnoses (Goldman classification I and II). 6 Here, we present two cases at the same institution which qualify as Goldman classification I and II discrepancies.…”

Section: Introductionsupporting

confidence: 78%

The autopsy is not dead: ongoing relevance of the autopsy

Vignau¹,

Milikowski²

2023

Autops Case Rep

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Background Autopsy requests have been trending downward for a variety of factors. There are differences between pre- and postmortem diagnoses. Autopsies remain a tool for education, public health research, quality control, and closure for families. Objective We report two cases that illustrate the utility of autopsy for uncovering contributing factors in the death of these patients and highlight their ongoing importance. Design Clinical and autopsy investigation of two individuals and illustration of the importance of autopsy findings which, had they been diagnosed premortem, could have changed the outcome. Cases were evaluated using the Goldman criteria for discrepancies between premortem clinical diagnoses and postmortem autopsy findings. Results In the first case, the patient had been previously admitted due to a non-ST elevation myocardial infarction months before the fatal event. The autopsy showed an undiagnosed clear cell carcinoma of the ovary. She expired due to a massive myocardial infarction secondary to neoplasm induced hypercoagulable state. The degree of pre-mortem/postmortem diagnostic discrepancy makes this a Goldman Class I error. In the second case, the patient presented to the emergency department with symptoms of Guillain-Barré Syndrome (GBS), for which he was treated. Abdominal masses were discovered; however, the patient decompensated before workup was completed. A high-grade B-cell lymphoma was confirmed but would not have altered the outcome, making this a Goldman class II error. Conclusions The autopsy remains a relevant and necessary tool for physicians and society. It assists in the establishment of diagnoses, measurement of treatment quality, the providence of public health metrics, and closure to the survivors.

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Section: Introductionsupporting

confidence: 78%

The autopsy is not dead: ongoing relevance of the autopsy

Vignau¹,

Milikowski²

2023

Autops Case Rep

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“…Repeated and goal-directed bedside ultrasonography allows physicians to monitor the condition of the veins of the patient's extremities. Nevertheless, VTE remains one of the most common unsuspected autopsy findings in critically ill patients 1 1 1 1 [6]. Moreover, the necessity of computed tomography pulmonary angiography (CTPA) should be carefully evaluated due to the risk during transportation and nephrotoxicity caused by contrast agents.…”

Section: Introductionmentioning

confidence: 99%

“…6,734 patients were retrieved from the Medical Information Mart for Intensive Care-III database version 1.4 (MIMIC-III v1.4) and was used for model development and internal validation. Data from a total of 168 patients from Nanfang Hospital were used for external validation.…”

mentioning

confidence: 99%

Development and Validation of a Risk Assessment Model for Venous Thromboembolism in Patients With Invasive Mechanical Ventilation

Lin¹,

Zhang²,

Lin³

et al. 2022

Cureus

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BackgroundPatients with invasive mechanical ventilation may be at high risk of acquiring venous thromboembolism (VTE). We aim to develop risk assessment models for predicting the improvement of VTE in invasively ventilated patients. MethodologyA total of 6,734 invasively ventilated patients enrolled from the Medical Information Mart for Intensive Care-III (MIMIC-III) database were used as input for model development and internal validation, while data from 168 patients from Nanfang Hospital were used for external validation. Logistic regression was performed based on predictive factors derived from least absolute shrinkage and selection operator (LASSO) regression analysis and logistic regression with backward selection to develop two Risk Assessment Models (RAM), namely, I and II, for the prediction of VTE, respectively. Model selection was performed by evaluation of the area under the receiver operating characteristic curve (AUC), the goodness of fit with calibration curves, and decision curve analyses (DCA). ResultsRAM-I included prior history of VTE, in-hospital immobilization, infection, glucose, the use of antiplatelet, and activated partial thromboplastin time (APTT) as variables, while RAM-II included prior history of VTE, in-hospital immobilization, infection, ischemic stroke, glucose, the use of antiplatelet and APTT as variables. Compared with RAM-I and ICU-Venous Thromboembolism Score, RAM-II exhibited better discrimination in the training dataset (AUC = 0.826), internal validation dataset (AUC = 0.771), and external validation dataset (AUC = 0.770). Additionally, DCA demonstrated that RAM-II was clinically beneficial. Inspection of the calibration curves revealed good agreement between the predictions and observations. ConclusionsA RAM for VTE in invasively ventilated patients was developed with reasonable performance.

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